Jamshid Tehranzadeh

Comparison of CT and MR imaging in musculoskeletal neoplasms.

Magnetic resonance (MR) and CT of 50 musculoskeletal neoplasms were compared to investigate the relative values of these modalities in the assessment and staging of musculoskeletal neoplasms and to determine how often they are complementary and when they are redundant. The material included 25 benign and 25 malignant neoplasms, of which 33 were skeletal and 17 were of soft tissue origin. Magnetic resonance was superior to CT with respect to all morphologic criteria except for cortical bone destruction, calcification, ossification, and the assessment of lytic and sclerotic changes in flat bones. Magnetic resonance was found to be complementary to CT in 48% of the cases (30% malignant, 18% benign). Use of both MR and CT was considered redundant in 52% of the cases (20% malignant, 32% benign). Magnetic resonance was found to be the modality of choice for all benign and malignant soft-tissue neoplasms. Both modalities are complementary and necessary for complete evaluation of malignant skeletal tumors. Benign skeletal tumors should be considered for evaluation by CT, MR, or both on an individual case basis.

Case report 415

Fig. 1. A technetium phosphate bone scan shows a localized area of increased activity in the mid line in the mid cervical region Fig. 2. A computed tomogram following a metrizamide myelogram obtained in the area of the lower cervical spine shows a multilobulated calcific and bony mass with a distinct cortex. Areas of attachment to the spinous process are present. No evidence of involvement of nerves or the spinal cord is apparent

Giant Cell Tumor of the Proximal Tibia: MR and CT Appearance

The magnetic resonance (MR) appearance of four cases of giant cell tumor (GCT) of the proximal tibia are described and the MR grading of these tumors is compared with CT and conventional radiography. Magnetic resonance showed the lesions to be well defined with respect to adjacent marrow and cortical bone. Homogeneous intermediate signal intensity or low signal within the tumors was seen on T1-weighted images. T2-weighted images showed mixed signal intensity with small “bright patches” of increased signal intensity in all four cases. No fluid levels were identified. Magnetic resonance was superior to CT and plain radiography in radiologic grading of the tumors. Computed tomography was superior in determining if cortical invasion was present. Intraarticular tumor extension was more accurately detected by MR and arthrotomography than CT. An MR manifestation of GCT of the proximal tibia is described which may be a common appearance of this tumor by this modality. Magnetic resonance is the procedure of choice in the radiologic grading of GCT.

A review of tibial spine fractures in bicycle injury

Nine tibial spine fractures were studied. Three of these nine cases included younger patients who fell from a bicycle and sustained an isolated avulsion fracture of the tibial spine. In all three cases, the medial tibial spines of the right knees were fractured. The other remaining five medial tibial fractures included two motorcycle and two automobile accidents, together with one basketball injury. One of the nine tibial spine fractures involved the lateral tibial spine.

Combined pelvic stress fracture and avulsion of the adductor longus in a middle- distance runner A Case Report

Stress fractures are not uncommon among runners and joggers,I-14 but pelvic stress fractures are relatively infrequent.1o Osteitis pubis attributed to avulsion of the rectus abdominis and adductor muscles is also reported as an unusual entity in runners.&dquo; The combination of pelvic stress fracture and avulsion of adductor longus in runners is very rare and, to our knowledge, has not been reported in English literature. We wish to report a case of stress fracture of the pubic ring combined with unilateral avulsion fracture caused by pulling of the adductor longus in a middle-distance runner.

Atypical healed stress fracture of the fibula masquerading as chronic osteomyelitis. A case report of magnetic resonance distinction.

proximal right fibula (Fig. 1). The lesion had a well-defined area of laminated periosteal reaction surrounding it. The center of the lesion contained a residue of the original bone which was narrowed probably due to the resorption. Some of the original bone was preserved and the lesion simulated a &dquo;bone within a bone&dquo; picture. Mixed areas of mottled lucencies and sclerosis were present. The radiographic differential diagnosis included a healed stress fracture, chronic osteomyelitis, and, less likely, a primary bone neoplasia. A 99mTc-phosphate bone scan showed mild increased uptake in this area. MR studies were obtained in coronal and axial planes. Tl weighted images demonstrated a homogeneously intense signal throughout the medullary cavity and the inner aspect of periosteal reaction surrounding the lesion (Fig. 2). T2 weighted images again showed increased signal from the lesion (Fig. 3). No soft tissue abnormalities were detected. Due to the uncertain radiographic appearance biopsy was performed. The pathologic specimen demonstrated normal cortical bone and no evidence of infection or tumor. (Fig. 4).

Posterior longitudinal ligament ossification myelopathy and hypothyroidism

Two elderly white women with a long history of hypothyroidism and myelopathy showed ossification in posterior longitudinal ligament at their cervical spine. Case histories are presented and the reported association of PLLO with other conditions discussed.

Case report 434

This 14-year-old girl, with a history of falling, presented with marked swelling and tenderness of the right wrist. The patient was in good health prior to the trauma. Physical examination revealed decreased breath sounds in the base of the right lung. The remainder of the physical examination was unremarkable. A plain film of the right wrist demonstrated a 5 cm lytic lesion in the distal end of the radius, associated with soft tissue swelling. Tomograms

Case report 408

Fig.1. An anteroposterior plain film roentgenogram of the area of the left hip shows a grossly destructive lesion involving the left pubic ramus and ischium. Only shreds of cortex remain Fig. 2 A, B. Plain film roentgenograms of the middle 2/3 of the left femoral shaft (anteroposterior and lateral projections) demonstrate an elongated, permeative, osteolytic lesion with considerable laminated periosteal reaction. The cortex is penetrated at a number of sites

Hemangiosarcoma of the Left Foot and Tibia: Case Report

A case of a hemangiosarcoma involving the bones of the foot in a diabetic patient who had swelling of the left foot is reported. Radiographs demonstrated multiple lytic areas throughout the bones of the foot. Clinically and radiographically, infection was suspected, but the biopsy revealed the presence of tumor. Metastases to the tibia were found and an above the knee amputation was performed. Chemotherapy was given, but 6 months later the patient died. Hemangiosarcoma is known to involve the different bones of the foot in a “multicentric” fashion and should be considered in the differential diagnosis of lytic lesions of multiple bones of the lower extremities.